Dual diagnosis is the condition of experiencing a mental health disorder and a substance use disorder at the same time. Also called co-occurring disorders, dual diagnosis is more common than many realize. According to the National Alliance on Mental Illness, as of 2021, around 19.4 million adults in the United States were living with both a mental illness and a substance use disorder.
Treating dual diagnosis isn’t about picking one issue to fix first. It requires an integrated approach that addresses both challenges at the same time. When only one condition is treated, the other can worsen and trigger relapse or deeper emotional distress.
What Does Dual Diagnosis Look Like?
The combination of disorders can vary widely. Some of the most common pairings include:
- Depression and alcohol use
- Anxiety and prescription drug misuse
- Bipolar disorder and stimulant abuse
- PTSD and opioid addiction
- Schizophrenia and cannabis or alcohol use
People with dual diagnosis often use substances to self-medicate painful emotions or symptoms, such as using alcohol to manage panic or taking stimulants to cope with fatigue from depression. Unfortunately, this often worsens symptoms over time.
Signs of a Dual Diagnosis
Because the symptoms of mental illness and substance use often overlap, spotting a dual diagnosis can be difficult, even for the person experiencing it.
Some common signs include:
- Using drugs or alcohol to cope with mood swings, anxiety or trauma
- Feeling like one condition is making the other worse
- Increasing isolation or difficulty maintaining relationships
- Trouble keeping up with responsibilities
- History of relapse after substance treatment
- Worsening mental health symptoms during withdrawal or recovery
If someone has already been diagnosed with a mental health disorder but struggles to stay sober — or vice versa — dual diagnosis treatment may be needed.
Why Dual Diagnosis Needs Specialized Care
Treating only one part of the problem rarely works. For example:
- Someone may enter rehab for alcohol addiction but leave without addressing underlying trauma or depression — increasing the risk of relapse.
- Others may get mental health care but continue using drugs that interfere with medication or therapy.
Integrated treatment offers support for both issues — often with a combination of therapy, medication management, peer support and relapse prevention strategies. The best dual-diagnosis programs understand how the two conditions interact and treat them as part of the same system.
Effective Treatments for Dual Diagnosis
There’s no one-size-fits-all approach, but evidence-based treatment often includes:
- Integrated therapy. Cognitive behavioral therapy, dialectical behavior therapy and trauma-informed care can address substance use and mental health symptoms.
- Medication management. Antidepressants, mood stabilizers or antipsychotics (such as Suboxone or naltrexone) may be prescribed alongside medications that support sobriety.
- Support groups. Peer-based programs, such as Dual Recovery Anonymous or groups offered through NAMI, provide support from others facing the same challenges.
- Case management and holistic care. Housing, employment support, nutrition and social skills are often part of long-term recovery for dual diagnosis.
- Trauma-informed care. Because many individuals with co-occurring disorders have a history of trauma, treatment must prioritize emotional safety and empowerment.
The Role of Family and Social Support
Loved ones play a major role in recovery, but support needs to be informed and healthy. If you have a friend or family member with a dual diagnosis:
- Educate yourself on both conditions.
- Avoid enabling behaviors or rescuing from consequences.
- Set clear, loving boundaries.
- Encourage treatment without forcing it.
- Take care of your own mental health.
Groups such as Al-Anon or Nar-Anon or therapy for families of those with co-occurring disorders can be helpful for support and guidance.
Challenges in Diagnosing Dual Disorders
Because substance use can mask or mimic mental health symptoms — and vice versa — proper diagnosis can take time. Some people may be misdiagnosed or go years without effective treatment.
It’s important to work with providers who specialize in dual diagnosis and understand how the two conditions interact. Treatment should be personalized, not rushed.
Frequently Asked Questions
There’s no single cause. Genetics, environment, trauma and brain chemistry all play a role. Some people use substances to cope with undiagnosed mental illness. Others develop mental health issues after prolonged substance use.
Yes. Recovery is absolutely possible with the right care. Many people live full, stable lives after receiving integrated treatment for both conditions.
No. In fact, it often makes the most sense to address substance use and mental health concerns at the same time. Dual-diagnosis treatment is specifically designed for people who may still be using substances, are in withdrawal, or are just beginning sobriety. Treating both conditions together increases the effectiveness of care and supports lasting recovery.
It depends on severity. Inpatient programs may be better for those with unstable symptoms or high relapse risk. Outpatient care can work for those with support at home and stable functioning. The key is individualized treatment.
It’s difficult to watch, but pushing too hard can backfire. Offer resources, stay connected and consider seeking professional guidance for yourself. Crisis hotlines can also help you navigate next steps.
You’re Not Alone — Support Is Available
Living with a dual diagnosis is challenging — but with the right care, healing isn’t only possible, it’s expected. Whether you’re struggling yourself or trying to support a loved one, know that treatment doesn’t have to be overwhelming or inaccessible.
Contact Us
At the Mental Health Hotline, we offer free, confidential support 24-7 for people facing mental health and substance use challenges. We can help you understand your options, find programs that treat co-occurring disorders and guide you toward your next step. Call today — your recovery matters, and you don’t have to face it alone.
